Access of older persons to health insurance and health-care services in viet nam: current state and policy options

Abstract Aim: The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support. Background: The purpose of WHO’s Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons. Method: This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis. Findings: The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: ‘Embracing life’, ‘Dealing with challenges’ and ‘Considering the future’.

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Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052767 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2767

Author(s):

Laura Nedzinskienė ◽

Elena Jurevičienė ◽

Žydrūnė Visockienė ◽

Agnė Ulytė ◽

Roma Puronaitė ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Chronic Disease ◽

National Health Insurance ◽

Health Care Services ◽

Age Groups ◽

Age Group ◽

Resource Usage ◽

Care Services ◽

Care Costs

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

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Umowy o udzielanie świadczeń opieki zdrowotnej zawierane przez Narodowy Fundusz Zdrowia (leczenie w ramach ubezpieczenia zdrowotnego) a leczenie na zasadach komercyjnych. Implikacje prawne i praktyczne

10.31338/2544-3135.si.2020-86.9 ◽

2021 ◽

pp. 141-151

Author(s):

Paweł Lipowski

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Providers ◽

Health Care Services ◽

Legal Status ◽

Healthcare Services ◽

Care Providers ◽

Care Services ◽

Public Payer ◽

Universal Health

The aim of this study is to identify the legal characteristics of contracts for the health care services provided by a public payer, i.e. the National Health Fund (NFZ) as part of treatment covered by universal health insurance, as compared to those provided by the health care providers with public or private legal status. This issue is discussed in relation to the legal conditions for the treatment of patients on a commercial basis in those institutions (private or public) which have contracts for the provision of healthcare services under the general health insurance (so-called contracts). The discussion is presented based on author’s own observations, resulting both from his scientific studies in the field of medical law and his work in various entities operating in the health care system.

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COMMUNITY-BASED HEALTH INSURANCE SCHEME IN A RURAL COMMUNITY OF NORTH WEST NIGERIA: A ROADMAP TO ACHIEVING UNIVERSAL HEALTH COVERAGE.

Kanem Journal of Medical Sciences ◽

10.36020/kjms.2020.1402.004 ◽

2020 ◽

Vol 14 (2) ◽

pp. 125-130

Author(s):

Lawal A ◽

◽

Gobir AA ◽

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Services ◽

Health Insurance Scheme ◽

Willingness To Participate ◽

Insurance Scheme ◽

Community Based ◽

Quality Health Care ◽

Community Based Health Insurance ◽

Care Services

Background: Community Based Health Insurance (CBHI) scheme is aimed at reducing out of pocket spending on health care services, ensuring final risk protection to all, especially the poor and the most vulnerable, improvement of quality of health care services, access and utilization as well as the promotion of equity. Objective: This research was aimed at determining willingness to participate in a community-based health insurance scheme among rural households in Katsina State. Method: A cross-sectional descriptive study was conducted in December 2016 among households of Batagarawa LGA, Katsina State. We used a pre-tested, electronic, semi-structured interviewer-administered questionnaire to obtain data from households that were selected using a multistage sampling technique and we analyzed the data using STATA version 13. Results: Most, (28.5%) of the respondents were in the age range of 30-39 years with a mean age of 35.5 years. Males were the dominant household heads (93%). Most were married (90%). Most, (90.5%) of households were willing to pay for a community-based health insurance scheme with a median premium of 100 Naira per household member per month. Conclusions: The high proportion of households willing to pay for the scheme should inform the decision of policy makers to design and maintain Community Based Health Insurance Scheme to improve access to and utilization of quality health care services.

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The shared experiences of insured members and the uninsured in health care access and utilization under Ghana’s national health insurance scheme: Evidence from the Hohoe Municipality

PLoS ONE ◽

10.1371/journal.pone.0244155 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244155

Author(s):

Suraiya Umar ◽

Adam Fusheini ◽

Martin Amogre Ayanore

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Health Care Services ◽

National Health Insurance Scheme ◽

Insurance Scheme ◽

Financial Barriers ◽

Care Access ◽

Care Services ◽

Barriers To Health

Background The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. Methods Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. Results Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. Conclusion The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana’s ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.

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Effect of Child Health Insurance Plan Enrollment on the Utilization of Health Care Services by Children Using a Public Safety Net System

PEDIATRICS ◽

10.1542/peds.110.5.940 ◽

2002 ◽

Vol 110 (5) ◽

pp. 940-945 ◽

Cited By ~ 24

Author(s):

S. Eisert ◽

P. Gabow

Keyword(s):

Health Care ◽

Health Insurance ◽

Child Health ◽

Public Safety ◽

Health Care Services ◽

Safety Net ◽

Insurance Plan ◽

Health Insurance Plan ◽

Care Services ◽

Child Health Insurance

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THE HEALTH-CARE NEEDS AMONG OLDER PERSONS IN AN INDONESIAN URBAN SETTING

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i7.18300 ◽

2017 ◽

Vol 10 (7) ◽

pp. 233

Author(s):

Setiawan E ◽

Poedjibudojo J K ◽

Tondok Ms

Keyword(s):

Health Care ◽

Older Persons ◽

Health Care Services ◽

Capital City ◽

Urban Setting ◽

Health Care Needs ◽

Care Needs ◽

Care Services ◽

Unmet Health Care Needs ◽

The Government

Objective: The unmet health-care needs among older persons population should be identified and anticipated due to hideous potential impacts. Ironically, no published study regarding this phenomenon was found in Indonesia. Derived from the Indonesian population and civil data, this study was conducted to identify the health-care needs of urban older people living on Java Island, the most populated island in Indonesia.Methods: A qualitative study was conducted in 3 subdistricts in Surabaya, the capital city of East Java, namely, Rungkut, Kenjeran, and Tenggilis. There were 9 focus group discussions (FGDs) conducted during March-August 2015. Participants in this study were recruited purposively, i.e., person in charge of “Karang Werda,” and the discussion explored thematically various topics in the area of unmet health needs phenomena related to: (1) Availability, (2) accessibility, and (3) acceptability. A FGD guide was developed to ensure in-depth discussion.Results: There were 90 older persons serving as volunteers who participated in this study. The unmet health-care needs addressed by participants in this study were (1) Integrated and specialized health-care services for older persons and (2) skillful yet age-friendly health-care personnel were needed by participants. Our findings pointed out that the unmet health-care needs in Indonesian urban settings were classified as primarily availability, accessibility, and acceptability issues.Conclusion: The government needs to take actions to solve the challenges related to the fulfillment of health-care needs among older persons in Indonesia. Further study of the health care personnel’s beliefs and attitudes in providing care among older persons needs to be conducted to provide a more holistic picture of the phenomena before making any strategy for the future Indonesia’s health-care system.

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Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

BioMed Research International ◽

10.1155/2020/4036830 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

N’doh Ashken Sanogo ◽

Sanni Yaya

Keyword(s):

Health Care ◽

Health Insurance ◽

Maternal Health ◽

Health Care Services ◽

Insurance Coverage ◽

Maternal Health Care ◽

Care Utilization ◽

Services Utilization ◽

Maternal Health Care Utilization ◽

Care Services

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

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